Employee Benefits: Medical Plans

Eligibility

Regular full-time and regular part-time employees working 20 hours per week are eligible on the first day of the month after employment.

Cost

USP pays all or a substantial portion of the cost of the coverage. Employee pre-tax bi-weekly contributions are:

Coverage Level Silver PlanGold PlanPlatinum Plan
Employee Only$0.00$12.07$22.06
Employee + 1$0.00$26.26$56.50
Employee + 2 or more$0.00$37.40$68.37

Amount of Benefit

United Healthcare offers three plan designs with comprehensive coverage allowing maximum employee choice:

Silver Plan—In-Network benefits only: Click to expand

  • $30 co-payment required for medical office visits
  • Annual deductibles, individual ($250) or family ($500) for major services including inpatient and outpatient hospitalization, durable medical equipment, and inpatient rehabilitation services
  • After satisfying deductible for major services, Plan requires 10% cost sharing for medical expenses up to an out-of-pocket maximum of $2,000 for individual coverage or $4,000 for family coverage
  • Open access plan; see a specialist without primary care physician referral
  • Hospital emergency room services require a $75 co-payment
  • Prescription coverage co-payments: $10, generic; $30, brand-name drugs; $50, nonpreferred brand-name drugs
  • 90-day prescription co-payments: $25, generic; $75, brand-name drugs; $125, nonpreferred brand-name drugs
  • In-network provider network is nationwide

Gold Plan—In-Network benefits only: Click to expand

  • $20 co-payment required for medical office visits
  • Annual deductibles, individual ($250) or family ($500) for major services including inpatient and outpatient hospitalization, durable medical equipment, and inpatient rehabilitation services
  • After satisfying deductible for major services, Plan pays 100% for medical expenses
  • Open access plan, see a specialist without primary care physician referral
  • Hospital emergency room services require a $50 co-payment
  • Prescription coverage co-payments: $10, generic; $25, brand-name drugs; $40, nonpreferred brand-name drugs
  • 90-day prescription co-payments: $25, generic; $62.50, brand-name drugs; $100, nonpreferred brand-name drugs
  • In-network provider network is nationwide

Platinum Plan—In- and Out-of-Network benefits: Click to expand

  • In-network:
    • $20 co-payment required for medical office visits
    • No deductibles for major services including inpatient and outpatient hospitalization, durable medical equipment, and inpatient rehabilitation services
    • Hospital emergency room services require a $50 co-payment
    • Prescription coverage co-payments: $10, generic; $25, brand-name drugs; $40, nonpreferred brand–name drugs
    • 90-day prescription co-payments: $25, generic; $62.50, brand-name drugs; $100, nonpreferred brand-name drugs
    • In-network provider network is nationwide
  • Out-of-network:
    • An individual ($250) or family deductible ($500)
    • After satisfying deductible for out-of-network services, Plan pays 80% of the Usual, Customary, and Reasonable (UCR) cost